1

Immunosignatures: a Platform Technology for Diagnosis and Discovery

Center for Innovations in Medicine

RUSNANO Stephen Albert Johnston Center for Innovations in Medicine HealthTell Russian American Anti Cancer Center

2

Current Center for Innovations In Medicine Projects

Health Monitoring/ Immunosignatures HealthTell, Inc Early Diagnosis Universal Preventative Frameshift Antigens Calviri, LLC Cancer Vaccine NextGen Antibiotics, Synbodies Anti-Virals

OBJECTIVE INVENTION COMPANY

3

Forbes Magazine, 1/19/2012

U.S. Healthcare Hits $3 Trillion

National Healthcare Expenditure – or NHE.

… NHE for 2012 is probably closer to $2.7 trillion but there’s this nagging bookkeeping accrual of about $300 billion where we (narrowly) avoided those darn pesky SGR cuts to Medicare. … That puts the real NHE at about $3 trillion for 2012 (+ about

4% for each year forward – as far as the eye can see). As one economist said – we don’t have a debt problem in this country – we have a healthcare problem.

http://www.forbes.com/sites/danmunro/2012/01/19/u-s-healthcare-hits-3-trillion/

$3 trillion is ~19% of the GDP for the US

Developing & under-developed countries:

71% of cancer deaths

5,053,872 deaths/yr.

Source: World Health Statistics 2006, published by the World Health Organization (WHO). WHO.

Developed (high-income/

industrialized):

29% of cancer deaths

Cancer Deaths Worldwide

2,054,897 deaths/yr.

7,108,769 total cancer

deaths/yr.

WHO: Imminent global cancer 'disaster'

“The total economic

impact of premature

death and disability

from cancer

worldwide was $895

billion in 2008.”

Anne Weston, picture of “How to Cure Cancer”, Time magazine web, June,2013

“When the stars come together cancer doesn’t stand a chance”

Development: $200B (1000 centers)

Cost/Year: $50B

Cost/Trtment ~$30,000 Physicists 10,000

Positron Emission Therapy

Personalized Medicine

1. Tumor DNA and/or RNA from ONE Individual is Sequenced 2. Analysis of Sequence Indicates the Right Drug to Use

3. Treatments often >$100,000 US

Post-Symptomatic Medicine

To Pre-Symptomatic Health

2009 GNP $14.7T

2009 Health Care Costs $2.5T

Graphs from “Trends in Health Care Costs and Spening, Kaiser Family Foundation, March 2009

http://www.kff.org/insurance/upload/7692_02.pdf; *gross income and tax data from the Tax Foundation

http://www.taxfoundation.org/news/show/250.html

Per capita health expenditure ~$8000

Median adjusted gross income in 2007 ~$33,000*

Median federal taxes per capita in 2007 ~$1,000

Total Medicare expenditures in 2004 ~$3B

Medicare expenditure per capita ~$1000

Transition from Post- to Pre-Symptomatic Medicine Requires System to Continuously Monitor Health of

Well People

Specifications Required: - Comprehensive - Sensitive – Early Detection - Simple - Inexpensive - Specificity – What is Wrong?

Can Not Do Early Detection of Disease

Blood Dilution Problem

104 Improvement in Detection Needed

Sci Transl Med 3, 109ra116 (2011); Sharon S. Hori, et al. Detection Strategies and Limitations Mathematical Model Identifies Blood Biomarker-Based Early Cancer

The Immune System Detects and Amplifies Signal

• 108 to 109 antibodies exist in serum

• A single reactive B cell encounters antigen and is activated

• Produces 5,000 to 20,000 antibodies per minute

• Divides every 70 hours

• Signal is amplified ~1011 times in one week

Immunosignatures: A universal, simple and cheap platform for disease diagnosis

Sykes et al. 2013 Trends Biotechnol. 31(1):45-51

CIM10K: 10,000 non-natural sequence peptides

Disease Normal Subjects

Peptides

Toward a World Without Patients

Array of 10K-350K, Addressable, Non-Natural Sequence Space Peptides

17

Immunosignature Process

Center for Innovations in Medicine

Add diluted blood

18

Immunosignature Process

Center for Innovations in Medicine

Wash

19

Immunosignature Process

Wash

20

• One array for all samples, human and nonhuman

• Very small quantity of blood required

• Scalability and low cost array fabrication

Immunosignature Process

Problem: How to Display Ab Diversity

Antibody Diversity 109

Different Ab/person

1019 Peptide Sequence Space In 3 x 105 peptides

Nature Does Not Always Know Best

- Life occupies an infinitesimally small part of potential sequence space

- Therefore there are many other sequences that could be useful

- Peptides on array are chosen to evenly sample random sequence space(3.5x105/ 1021 possibilities)

Consequences: Same set of peptides can be used for any diagnosis Super-fine resolution of antibody diversity

Monoclonal

Antibodies Bind

Distinct Patterns on

the Array

Stafford et al. Mol Cell Proteomics 2012. 11(4):M111.011593

Information from Each Feature

Intensity (#Ab/spot)

Isotypes IgG (4)

IgM IgE IgA

Amino Acid Sequence (Repeating Motifs)

Feature On Array

Peptide Microarray Vs ELISA

Sera

1:1,634,800

Secondary

Alone

Identifying The Immunosignature

Control

Disease

10,000 Peptides

p < 1x10 -6

& Fold Change

~ 100 informative

peptides

Train a Machine

Learning Algorithm

Disease Control

ROC Curve

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0 0.2 0.4 0.6 0.8 1 1.2

False Postitve Fraction

Tru

e P

osti

ve F

racti

on

Performance is Tested on a Second Group

Features of Immunosignatures

Same chip used for all diseases, all species Detects all antibodies: sugars, non-linear, modifications Historical sera samples work No sample preparation 10-100x more sensitive than ELISA

One Chip, Many Tests

West Nile Type 1 Diabetes Breast Cancer

Dry Blood Works as Well as Fresh Blood Dried vs. Undried Whole Blood Immunosignature Correlations

0 Week Dried vs. Undried Whole Blood

1 Week Dried vs. Undried Whole Blood

3 Week Dried vs. Undried Whole Blood

R2 = 0.919 R2 = 0.916 R2 = 0.843

30

Storage conditions: 25C

Platform 1: Printed Arrays of 10,000 Peptides

17 amino acids long, random sequence, and all amino acids except C are used. Two copies of the library are printed on a glass slide (~1200 peptides/cm2). Mass spectra available for all peptides spotted on the arrays.

31

• UV photolithography

• All chemistry performed

using coater/developer

• Large number of cycles

makes the process

challenging

32 32

Material in this presentation contains ASU and HealthTell Intellectual Property and is Confidential

Center for Innovations in Medicine

0

0.2

0.4

0.6

0.8

1

1.2

Ab1 Ab8 DM1A A 0.998

V 0.999

P 0.999

L 0.992

G 0.991

Y 0.992

F 0.998

S 0.998

N 0.998

Q 0.986

K 0.972

D 0.997

E 0.998

H 0.711

Stepwise Yield Analysis

His oxidized to Asn

G-Peg-GSGPQL-Tmpp G-Peg-GSGLAN-Tmpp

G-Peg-GSGFGS-Tmpp G-Peg-GSGFYY-Tmpp

Ab

8

Ab

1

DM

1A

Ab

8

Ab

1

DM

1A

Ab

8

Ab

1

DM

1A

Antibody Probe

Epitope

Cost per chip Vs volume

• Cost analysis includes • Labor cost

– Technicians need to run the tools

• Yield & QA cost

– Labor + reagents – Each batch sample set is

analyzed • Chemical/biochemical reagents

– Surface prep – Litho & resist steps – Amino-acid coupling

• Materials

– Wafer – Mask set

• Facility cost

– Rent, unitlity, & chemical disposal

• Tool maintenance • Packaging

9,033, $290

25,135, $108

45,164, $63

90,327, $35 180,655, $21

361,309, $13 $0

$50

$100

$150

$200

$250

$300

$350

5,000 50,000 500,000

Co

st p

er

chip

Number of chip

Cost per chip

Completed Wafer

Diced Slide 24 Arrays

Single Array Multiple Features

Single Feature

Array Production Breakdown: Wafer to Individual Spot

350K peptides/array

~50-Fold Improvement Over CIM10K Printed Arrays

OneTest™

Comprehensive Health Monitoring

Please Do Not Distribute 36

Valley Fever (Coccidiomycosis)

Coccidioides immitis spherule with endospores.

• About 30,000 reported cases annually

• Particularly prevalent the Sonoran desert

• While most cases mild, it can be life threatening

• Flu-like symptoms

Center for Innovations in Medicine

Classic Train/Test Example:

Valley Fever

• 10,000 peptides on original array

• 120 patients screened and analyzed

• 100 most informative peptides

selected and resynthesized

• Diagnostic array printed

Normal Infected

38

John Galgiani Univ. of Arizona

Outperforms Existing Diagnostic

Patients with Valley Fever Patients that did not have Valley Fever

• 90 blinded samples from patients presenting at the clinic

• Zero false positives (100% specificity)

• Zero false negatives (100% sensitivity)

All Patients with Valley Fever Presented with Zero CF Titers, but were later

shown to have the disease

39

Breast Cancer Test/Train using geographically distinct cohorts

Healthy Breast Cancer

Immunosignaturing Brain Tumors Collaborator: Adrienne C. Scheck, BNI

Not only can immunosignaturing detect the brain tumor, it can distinguish accurately between the common types of brain tumors

100% accurate detection training and testing on samples taken years apart using printed arrays

41

Alzheimer’s:

Alzheimer’s Disease Neuroimaging Initiative (10K)

Disease: ADNI collection of serum samples from Alzheimer’s Disease (AD) and non-AD controls Feature selection: 1 sided T-test, 50 peptides were selected Classification: 4 samples were called normal when they were Alzheimer’s (FN) Sensitivity=89%, NPV=92%, Accuracy=95%, specificity and PPV=100% Interpretation: AD signature blends gradually into controls with no clearly defined threshold

Alzheimer’s Disease Controls

Towards Comprehensive Testing

43

Astrocytoma

Oligo

den

dro

gliom

a

Mixed Oligo/Astro

Pancreatic Healthy controls BC stage 2, 3 Breast 2nd tumor

MM Pancreatitis GBM Ovarian

Sarcom

a

Lung

BC

stage 4

Valley Fever

15 Diseases Simultaneously Analyzed Stafford et al. 2014, PNAS in press

Cross Validation, 15 Diseases

44

Legutki et al Submitted

Dengue Fever

Valley Fever

Bordetella pertussis

Lyme Disease

West Nile Virus

Syphilis

Simultaneous Distinction of 6 Infection and Normal Sera

10k vs 330K comparison

Sample Correctly Identified Incorrectly Identified

DTRA 1 40 0

DTRA 2 32 0

DTRA 3 40 0

DTRA 4 49 0

DTRA 5 42 1

DTRA 6 41 0

DTRA 7 33 0

DTRA 8 46 0

Local Normal 59 0

Total 382 1

CIM10K KNN Classification Results using the 160 peptides

Sample Correctly Identified Incorrectly Identified

DTRA 1 12 0

DTRA 2 12 0

DTRA 3 12 0

DTRA 4 11 0

DTRA 5 31 0

DTRA 6 26 0

DTRA 7 27 0

DTRA 8 27 0

Local Normal 6 0

Total 164 0

HT330K KNN Classification Results using the 160 peptides

2.7x10-13 6.2x10-38 Minimal P-Value

Transition from Post- to Pre-Symptomatic Medicine Requires System to Continuously Monitor Health of

Well People

Specifications: - Comprehensive - Sensitive – Early Detection - Simple - Inexpensive - Specificity – What is Wrong?

48

Direct Mail-in of Samples

detected by image or symptoms start the treatment

detected by IMS start the treatment

closely monitor by IMS evaluate the treatment

Anti-CTLA4 Anti-PD-1

chemotherapy

Cancer is eradicated

With current diagnosis and treatment, the cancer death rate will be 585,720 in 2014.

Earlier diagnosis treatment, higher survival

Vision: Eradicating Cancer by Immunosignature Monitoring of Health

Goal: Complete Annual Wellness Test for Dogs

• A comprehensive

assessment of health

• Indicative of Health Status

• Derived from a single,

simple to use, low cost

test

Calviri, LLC

Which Vaccine is Protective?

Live PR8 Mock (PBS)

The Immunosignature Distinguishes Infected from Mock Infected Mice

73 Peptides Selected Using expression profile mapping.

Killed PR8 Predicted as More Effective Than Seasonal Trivalent Vaccines

Live vs Mock

Killed vs Mock

Live vs Mock

06/07 vs Mock

Live vs Mock

07/08 vs Mock

60 20 53

34 4 69

107 9 64

Challenge Results

Legutki and Johnston, 2013, PNAS (Embargoed In Press)

Immunosignature of Seasonal TIV Survivors Groups Survivors with The Killed PR8 Immunized

Legutki and Johnston, 2013, PNAS (Embargoed In Press)

38 Peptides Selected using a T test with p < 0.05 Benjamani and Hochberg MTC and >1.3x Fold Change

Survived Died

TIV Recipients Who Died Lack Specific Reactivity

Whole PR8 Virus ELISA in 2006-2007 TIV Recipients

Legutki and Johnston, 2013, PNAS (Embargoed In Press)

Survived Died

Missing Reactivity Aligns to NA195-219

Legutki, JB & Johnston, SA: PNAS (Embargoed In Press) GuiTope: Halperin, R. 2012. BMC Bioinformatics 13:1

Summary

• Immunosignature Technology is a Universal

Diagnostic Platform

• It is Simple, Sensitive and Potentially

Inexpensive

• It Also Can Be Employed as a Discovery Tool

Russian-American Collaboration

Altai State University

Professor Andrei Chapoval, Director

Acknowledgements • Innovations In Medicine

– Neal Woodbury, co-director

– Chris Diehnelt

– John Lainson

– Zbigniew Cichacz

– Phillip Stafford

– Zhan-Gong Zhao

– Donnie Shepard

– Bart Legutki

– Andrey Loskutov

– Penny Gwynne

– Loren Howell

– Douglas Daniel

– Rebecca Halperin

– Lucas Restrepo

– Luhui Shen

– Hu Duan

– Debra Hansen

– Pattie Madjidi

60

• HealthTell, Inc.

– Bill Colston

– Kathryn Sykes

– David Smith

– Fabrication Team

• NextVal, Inc.

– Matthew Greving

• Complex Adaptive Systems Initiative

– George Poste

• Other Collaborators

– John Galgiani, U. of Arizona

– Hoda Anton-Culver, UC Irvine

– Sam Hanash, Fred Hutchinson Cancer Center

– Adi Gazdar, UT Southwestern

– Adrienne Scheck, Mayo Clinic

– Dawn E. Jaroszewki, Mayo Clinic

$Funding: The Biodesign Institute at ASU HealthTell, Inc. DTRA, NSF, DARPA, ARO